Adolescent tobacco use in public and private schools in Uruguay: A comparative qualitative analysis

The aims of this study were to compare behaviors, perceptions and intra-personal and socio-environmental factors associated with cigarette use between gender (boys and girls), grade (1st and 2nd year of middle school), SES (high, middle and low) and school type (private and public). Focus group were conducted in the summer of 2012 and fall of 2013 among four secondary schools in Montevideo, Uruguay. A total of 4 focus groups (stratified by girls and boys in 7th and 8th grade) were led in each school, composed of 4-6 students each. Themes related to reasons for and against, and methods of smoking cigarettes were identified. Data analysis was performed utilizing NVivo software, deductive and inductive content analysis. The most overwhelming factors reported related to adolescent smoking were that smoking was a social event, performed in groups, for attention from their peers. Those who smoked alone were cited to be depressed, or to have family problems. Furthermore, focus groups interviews revealed that adolescents had easy access to cigarettes for purchase through small family owned grocery stores, even though there are laws preventing the sale of cigarettes to minors. The results show that there are not many differences between strata related to cigarette use in adolescents. The differences that do exist are most apparent across gender. Girls and boys had slightly different perceptions about drug harm: girls believed that tobacco was more problematic than marijuana, while boys believed the reverse. Boys were also more likely to believe that individuals smoked to be part of a group than girls. Last, while boys and girls both reported that they saw smokers in the movies, girls were more likely to report that they were encouraged to smoke through observing smokers in the movies. With regards to socio-economic status (SES), there were some observed differences as well. Those who attended a higher SES school reported that there was a positive association between low student academic achievement and smoking, whereas those of lower socioeconomic status were more likely to believe that there was no correlation. In addition, when speaking about adolescents smoking inside their house, those of a high SES reported that adolescents only smoked inside if their parents were also smokers. Overall, the data from the focus groups suggests that an ecological approach to anti-tobacco regulation in Uruguay would be most effective to stymie tobacco use in adolescents